ABSTRACT
BACKGROUND: The progressive ageing of the population is leading to an increase in multimorbidity and polypharmacy, which in turn may increase the risk of hospitalization and mortality. The enhancement of care with information and communications technology (ICT) can facilitate the use of prescription evaluation tools and support system for decision-making (DSS) with the potential of optimizing the healthcare delivery process. OBJECTIVE: To assess the effectiveness and cost-effectiveness of the complex intervention MULTIPAP Plus, compared to usual care, in improving prescriptions for young-old patients (65-74 years old) with multimorbidity and polypharmacy in primary care. METHODS/DESIGN: This is a pragmatic cluster-randomized clinical trial with a follow-up of 18 months in health centres of the Spanish National Health System. Unit of randomization: family physician. Unit of analysis: patient. POPULATION: Patients aged 65-74 years with multimorbidity (≥ 3 chronic diseases) and polypharmacy (≥ 5 drugs) during the previous 3 months were included. SAMPLE SIZE: n = 1148 patients (574 per study arm). INTERVENTION: Complex intervention based on the ARIADNE principles with three components: (1) family physician (FP) training, (2) FP-patient interview, and (3) decision-making support system. OUTCOMES: The primary outcome is a composite endpoint of hospital admission or death during the observation period measured as a binary outcome, and the secondary outcomes are number of hospital admission, all-cause mortality, use of health services, quality of life (EQ-5D-5L), functionality (WHODAS), falls, hip fractures, prescriptions and adherence to treatment. Clinical and sociodemographic factors will be explanatory variables. STATISTICAL ANALYSIS: The main result is the difference in percentages in the final composite endpoint variable at 18 months, with its corresponding 95% CI. Adjustments by the main confounding and prognostic factors will be performed through a multilevel analysis. All analyses will be carried out in accordance to the intention-to-treat principle. DISCUSSION: It is important to prevent the cascade of negative health and health care impacts attributable to the multimorbidity-polypharmacy binomial. ICT-enhanced routine clinical practice could improve the prescription process in patient care. TRIAL REGISTRATION: ClinicalTrials.gov NCT04147130 . Registered on 22 October 2019.
Subject(s)
Multimorbidity , Polypharmacy , Aged , Chronic Disease , Humans , Primary Health Care/methods , Quality of Life , Randomized Controlled Trials as TopicABSTRACT
BACKGROUND: Multimorbidity is a global health challenge that is associated with polypharmacy, increasing the risk of potentially inappropriate prescribing (PIP). There are tools to improve prescription, such as implicit and explicit criteria. OBJECTIVE: To estimate the prevalence of PIP in a population aged 65 to 74 years with multimorbidity and polypharmacy, according to American Geriatrics Society Beers Criteria® (2015, 2019), the Screening Tool of Older Person's Prescription -STOPP- criteria (2008, 2014), and the Medication Appropriateness Index -MAI- criteria in primary care. METHODS: This was an observational, descriptive, cross-sectional study. The sample included 593 community-dwelling elderly aged 65 to 74 years, with multimorbidity and polypharmacy, who participated in the MULTIPAP trial. Socio-demographic, clinical, professional, and pharmacological-treatment variables were recorded. Potentially inappropriate prescribing was detected by computerized prescription assistance system, and family doctors evaluated the MAI. The MAI-associated factors were analysed using a logistic regression model. RESULTS: A total of 4,386 prescriptions were evaluated. The mean number of drugs was 7.4 (2.4 SD). A total of 94.1% of the patients in the study had at least one criterion for drug inappropriateness according to the MAI. Potentially inappropriate prescribing was detected in 57.7%, 43.6%, 68.8% and 71% of 50 patients according to the explicit criteria STOPP 2014, STOPP 2008, Beers 2019 and Beers 2015 respectively. For every new drug taken by a patient, the MAI score increased by 2.41 (95% CI 1.46; 3.35) points. Diabetes, ischaemic heart disease and asthma were independently associated with lower summated MAI scores. CONCLUSIONS: The prevalence of potentially inappropriate prescribing detected in the sample was high and in agreement with previous literature for populations with multimorbidity and polypharmacy. The MAI criteria detected greater inappropriateness than did the explicit criteria, but their application was more complex and difficult to automate.
Subject(s)
Inappropriate Prescribing/prevention & control , Multimorbidity , Polypharmacy , Potentially Inappropriate Medication List , Aged , Cross-Sectional Studies , Female , Geriatrics/methods , Humans , Independent Living , Male , Prevalence , Primary Health Care , Risk , SpainABSTRACT
OBJECTIVE: Analyze the correspondence between health technologies (HT) to develop --doctor's opinion-- and the ones assessed by Spanish Agencies for Health Technologies Assessment. DESIGN: Response analysis of HT obtained from participant doctors. Comparison with assessment reports of agencies. SETTING: Andalusian Public Health System; 2003. Spanish Agencies for Health Tecnologies Assessment. PARTICIPANTS: One hundred and forty-seven specialised doctors of 46 MIR specialties. METHOD: Non-random sample. Andalusian experts and leaders professional selected. Exhaustive searching in Internet or assessment reports of HT. A "score of effort" (SE) was calculated for each Agency. RESULTS: Seven HT groups agree with agency assessment reports: systems and communication network (SE, 0.78%-6.25%); mollecular biology for diagnosis and treatment (SE, 3.12%-42.73%); functional image technologies, monitorization, quick diagnosis, and non-invasive methods (SE, 3.93%-31.25%); lasertherapy, microsurgery, endoscopic surgery, minimally invasive, virtual and remote-controlled surgery (SE, 3.22%-31.25%); stem cells, artificial organs, and xenotransplantation (SE, 0.78%-12.34%); psychosocial interventions (SE, 0.78%-7.69%); management, planification and record systems (SE, 9.67%-76.92%). Two additional cathegories not cited by doctors but evaluated by agencies were identified: Effectiveness of therapeutic and disgnostic implanted strategies and sterilization methods of surgical material (SE, 3.86%-43.18%); Matural drugs, alternative therapies (SE, 1.78%-6.25%). CONCLUSIONS: Greater concordance between doctors and agencies in: mollecular biology, functional image technology, new surgical techniques and management, planification and record systems.
Subject(s)
Medical Laboratory Science , Medicine , Specialization , Technology Assessment, Biomedical , SpainABSTRACT
Objetivo. Analizar la correspondencia entre tecnologías sanitarias (TS) a desarrollar en opinión de médicos especialistas y las evaluadas por las agencias de evaluación de tecnologías españolas. Diseño. Análisis de respuestas sobre TS obtenidas de los médicos participantes. Comparación con informes de evaluación de las agencias. Emplazamiento. Sistema Sanitario Público Andaluz, Agencias Españolas de Evaluación de Tecnologías Sanitarias. Participantes. Se incluyó en el estudio a 147 especialistas de las 46 especialidades MIR. Método. Muestreo no probabilístico. Selección de expertos y líderes profesionales andaluces. Búsqueda exhaustiva en internet de informes de evaluación de tecnologías. Elaboración de indicador de esfuerzo dedicado por las agencias (IE). Resultados. Identificadas 7 categorías de TS coincidentes con las evaluaciones de agencias: sistemas y redes de comunicación (IE, 0,78-6,25%); biología molecular para diagnóstico y tratamiento (IE, 3,12-42,73%); tecnologías de imagen funcional, monitorización, diagnósticos rápidos y métodos no invasivos (IE, 3,93-31,25%); laserterapia, microcirugía, cirugía endoscópica, cirugía mínimamente invasiva y virtual teledirigida (IE, 3,22-31,25%); células madre, órganos artificiales y xenotrasplantes (IE, 0,78-12,34%); intervenciones psicosociales (IE, 0,78-7,69%); sistemas de información, planificación y gestión (IE, 9,67-76,92%). Se identificaron dos categorías no citadas evaluadas por las agencias (y efectividad de estrategias diagnósticas y terapéuticas implantadas y técnicas de esterilización de material quirúrgico (IE, 3,86-43,18%); drogas naturales, terapias alternativas (IE, 1,78-6,25%). Conclusiones. Mayor coincidencia entre profesionales y agencias en: biología molecular, tecnología de imagen funcional, nuevas técnicas quirúrgicas y planificación, gestión y sistemas de información
Objective. Analyze the correspondence between health technologies (HT) to develop --doctor's opinion-- and the ones assessed by Spanish Agencies for Health Technologies Assessment. Design. Response analysis of HT obtained from participant doctors. Comparison with assessment reports of agencies. Setting. Andalusian Public Health System; 2003. Spanish Agencies for Health Tecnologies Assessment. Participants. One hundred and forty-seven specialised doctors of 46 MIR specialties. Method. Non-random sample. Andalusian experts and leaders professional selected. Exhaustive searching in Internet or assessment reports of HT. A "score of effort" (SE) was calculated for each Agency. Results. Seven HT groups agree with agency assessment reports: systems and communication network (SE, 0.78%-6.25%); mollecular biology for diagnosis and treatment (SE, 3.12%-42.73%); functional image technologies, monitorization, quick diagnosis, and non-invasive methods (SE, 3.93%-31.25%); lasertherapy, microsurgery, endoscopic surgery, minimally invasive, virtual and remote-controlled surgery (SE, 3.22%-31.25%); stem cells, artificial organs, and xenotransplantation (SE, 0.78%-12.34%); psychosocial interventions (SE, 0.78%-7.69%); management, planification and record systems (SE, 9.67%-76.92%). Two additional cathegories not cited by doctors but evaluated by agencies were identified: Effectiveness of therapeutic and disgnostic implanted strategies and sterilization methods of surgical material (SE, 3.86%-43.18%); Matural drugs, alternative therapies (SE, 1.78%-6.25%). Conclusions. Greater concordance between doctors and agencies in: mollecular biology, functional image technology, new surgical techniques and management, planification and record systems
